One of the most frequently asked questions for manual therapy clinicians is “what is the difference between physiotherapy, osteopathy and chiropractic?”
This blog post aims to add to the numerous attempts to answer the question, many of which can be found online.
So, how am I qualified to answer the question? I am a practicing osteopath of 10 years, a clinical director of a multidisciplinary team including physiotherapists, osteopaths and chiropractors, and I have been involved in delivery of osteopathic education at undergraduate level for around 5 years.
Most other attempts to answer this question focus largely on the historical differences of the three professions. However, I will attempt to answer the question based on current thoughts, education and understanding within the three professions. Over the years orthodox medicine and doctor’s treatments have developed with research and experience, similarly treatments delivered by physiotherapists, osteopaths and chiropractors have evolved and changed. Doctors no longer perform brain surgery (lobotomy) for mental health issues, a practice which was not unusual early last century; chiropractors no longer all subscribe to the ‘spinal subluxation’ model of chiropractic treatment.
I like to use the following analogy to describe the difference;
“Osteopaths, Chiropractors and Physiotherapists are like iPads, Samsung tablets, Windows tablets. Here’s why; a new graduate therapist is a blank canvas, they have had some basic training and you can be assured that they have reached a level of safety and competence, however they don’t have experience and postgraduate training which really shapes how musculoskeletal therapists operate. Similarly, all tablets have some basic functionality, however the way the tablet is used is ultimately guided by which apps the owner downloads. The apps downloaded to a tablet are the same (in this analogy) as experience, further training and research for a therapist.
For example, my 9 year old niece’s iPad tablet, is likely to have the same apps, functionality and use as her best friends Samsung tablet (Minecraft, CBBC & Poke’mon ). Likewise, my iPad has the same apps, functionality and use as my brother’s windows tablet (news apps, at least 3 weather apps, internet banking, skyscanner, trainline, social media etc). The use of my iPad and its functionality is very different to my niece’s iPad, despite both being called iPads. However, my iPad and my brother’s Windows tablet have completely different names, but function in a similar way.
Likewise, physiotherapist A and physiotherapist B may choose to manage the same patient using two completely different treatment approaches (despite both being physiotherapists). Whilst osteopath A may choose to manage a similar patient in exactly the same way as physiotherapist B (despite having completely different professional titles). Chiropractor A may feel the best way to manage a similar patient is in line with physiotherapist A (despite being members of different professions). The treatment you receive from physiotherapists, osteopaths and chiropractors is likely to be shaped by their postgraduate training and experience, rather than by their professional title”
The table below is a snapshot of the three professions, you will note that the similarities far outweighthe differences.
| Physiotherapist | Osteopath | Chiropractor | |
| Musculoskeletal specialists | ✓ | ✓ | ✓ |
| BSc or MSc degree education | ✓ 3 Years | ✓ 4 Years | ✓ 4 years |
| NHS or Private | Both (mainly NHS) | Both (mainly private) | Both (mainly private) |
| Joint and muscle manipulation | ✓ | ✓ | ✓ |
| Able to take a case history, assess and diagnose. | ✓ | ✓ | ✓ |
| May use additional therapies such as acupuncture, ultrasound, TENs, Laser | ✓ | ✓ | ✓ |
| Prescribe exercises and lifestyle advice | ✓ | ✓ | ✓ |
| Consult fees reclaimable through private medical insurance. | ✓ | ✓ | ✓ |
| Obliged to complete minimum hours of CPD training each year | ✓ | ✓ | ✓ |
Pretty similar, right? There are however some subtle differences. For example, the emphasis of differing treatment and management styles. As a generalisation, and by no means a rule the following may loosely apply;
• Chiropractic treatment sessions are often 10-20 minutes. Osteopathy and physiotherapy appointment often last slightly longer at 20-60 minutes.
• The ‘hands-on’ element of chiropractic treatment may be predominantly focussed on spinal manipulation (‘popping’ joints). Physiotherapists and osteopaths may include spinal manipulation within their treatment plans, however also regularly choose to use stretching or other methods to mobilise joints.
• Physiotherapists may do less ‘hands-on’ therapy and often focus management on exercise. However, all good osteopaths and chiropractors who are “worth one’s salt” should also prescribe exercises for patients as part of their management plan.
• Ongoing maintenance / top up / wellness treatments are more commonly recommended by chiropractors and osteopaths than physiotherapists (although many physiotherapists do also offer these). For more information on maintenance treatments, and if they might be suitable for you, please check out our maintenance treatments blog.
To summarise there are more similarities than differences. There are good and not so good in all occupations. The chances of success from your treatment, is likely to be affected more by the choices you make, than the choices your clinician makes. However, if you’re given advice which is not aligned with recent best practice, this will affect your treatment and outcomes – so try to choose a practitioner who is passionate about their work, and invests their time to ensure their skills and training are up to date.
